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Case Study Discussion For Pelvic Pain And Abnormal Menstrual Bleeding

Case Study Discussion For Pelvic Pain And Abnormal Menstrual Bleeding

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During week #5 there is a case study discussion assignment due. You will develop your patient case study related to a patient that demonstrates a gynecological disease process in your practicum experience or professional practice that would be your biggest challenge as a clinician. Note: Possibly use your “FNP or AGPCNP Skills and Procedures Self-Assessment” in your practicum experience to guide your case study selection.

  • Use the Focused SOAP Note Template found in the Learning Resources to support your discussion. Complete a Focused SOAP note critically analyze this and focus your attention on the diagnostic tests.
  • Based on your case study, post by day #3 in the discussion board the following:
    • POST a Focused SOAP NOTE only and describe your case study.
    • Provide a differential diagnosis (dx) with a minimum of 3 possible conditions or diseases.
    • Define what you believe is the most important diagnosis. Be sure to include the priority in conducting your assessment.
    • Explain which diagnostic tests and treatment options you would recommend for your patient and explain your reasoning.
    • Also, share with your colleagues your experiences as well as what you learned from these experiences.
    • APA Format
    • Need 3 Scholarly References Case Study Discussion For Pelvic Pain And Abnormal Menstrual Bleeding

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Use your Learning Resources and/or evidence from the literature to support your thinking and perspectives. Respond to at least two of your colleagues’ posts on two different days and explain how you might think differently about the types of tests or treatment options that your colleagues suggested and why. Use your learning resources and/or evidence from the literature to support your position.

Based on your case study, post the following:

  • POST A Focused SOAP NOTE only and describe your case study.
  • Provide a differential diagnosis (dx) with a minimum of 3 possible conditions or diseases.
  • Define what you believe is the most important diagnosis. Be sure to include the priority in conducting your assessment.
  • Explain which diagnostic tests and treatment options you would recommend for your patient and explain your reasoning.
  • Also, share with your colleagues your experiences as well as what you learned from these experiences.

Use your Learning Resources and/or evidence from the literature to support your thinking and perspectives.

 

Class Resources

  • Schuiling, K. D., & Likis, F. E. (2022). Gynecologic health care(4th ed.). Jones and Bartlett Learning.
    • Chapter 23, “Urinary Tract Infections” (pp. 469–478)
    • Chapter 24, “Urinary Incontinence” (pp. 479–492)
    • Chapter 23, “Menstrual-Cycle Pain and Premenstrual Syndrome” (pp. 495–510)
    • Chapter 26, “Normal and Abnormal Uterine Bleeding” (pp. 511–526)

RESOURCES FOR LGBTQ+

  • Aisner, A. J., Zappas, M., & Marks, A. (2020). Primary Care for Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning (LGBTQ) PatientsLinks to an external site.. The Journal for Nurse Practitioners, 16(4), 281–285. https://go.openathens.net/redirector/waldenu.edu?url=https://doi.org/10.1016/j.nurpra.2019.12.011
  • Office of Disease Prevention and Health Promotion (ODPHP). (2020, April 18). Lesbian, gay, bisexual, and transgender healthLinks to an external site.. https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health Case Study Discussion For Pelvic Pain And Abnormal Menstrual Bleeding
  • Sadlak, C. A., Boyd, C. J., & Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ)
    Health Expert Panel (2016). American Academy of Nursing on Policy: Health care services for transgender individuals: Position statementLinks to an external site.. https://www.nursingoutlook.org/action/showPdf?pii=S0029-6554%2816%2930120-8
  • Wingo, E., Ingraham, N., & Roberts, S. C. M. (2018). Reproductive Health Care Priorities and Barriers to Effective Care for LGBTQ People Assigned Female at Birth: A Qualitative StudyLinks to an external site.. Women’s Health Issues, 28(4), 350–357. https://go.openathens.net/redirector/waldenu.edu?url=https://doi.org/10.1016/j.whi.2018.03.002

FNP RESOURCES

  • American Academy of Nurse Practitioners Certification Board (AANPCB). (2018). Welcome to the American Academy of Nurse Practitioners Certification BoardLinks to an external site.. https://www.aanpcert.org/
  • American Academy of Nurse Practitioners National Certification Board, Inc. (AANPCB). (2018). FNP & AGNP Certification Candidate HandbookLinks to an external site.. https://www.aanpcert.org/resource/documents/AGNP%20FNP%20Candidate%20Handbook.pdf

CLINICAL GUIDELINE RESOURCES

As you review the following resources, you may want to include a topic in the search area to gather detailed information (e.g., breast cancer screening guidelines; CDC for zika in pregnancy, etc.).

  • American Cancer Society, Inc. (ACS). (2020). Information and Resources about Cancer: Breast, Colon, Lung, Prostate, SkinLinks to an external site.. https://www.cancer.org/
  • American College of Obstetricians and Gynecologists (ACOG)Links to an external site.. (2020).  https://www.acog.org/
  • American Nurses Association (ANA). (n.d.). Lead the profession to share the future of nursing and health careLinks to an external site.. https://www.nursingworld.org/
  • Centers for Disease Control and Prevention. (CDC). (n.d.). CDC in actionLinks to an external site.. https://www.cdc.gov
  • HealthyPeople 2030. (2020). Healthy People 2030 FrameworkLinks to an external site..  https://www.healthypeople.gov/2020/About-Healthy-People/Development-Healthy-People-2030/Framework
  • The American Association of Nurse Practitioners (AANP). (2020). What’s Happening at your associationLinks to an external site.. https://www.aanp.org/
  • Document:Focused SOAP Note Template Download Focused SOAP Note Template(Word document) Case Study Discussion For Pelvic Pain And Abnormal Menstrual Bleeding

Episodic/Focused SOAP Note

 Patient Information:

ET, 34, Female, Caucasian

S.

CC (chief complaint): Pelvic pain and abnormal menstrual bleeding over the past six months.

HPI: Ms. Emily Thompson is a 34-year-old Caucasian female who presents with a chief complaint of pelvic pain and abnormal menstrual bleeding over the past six months. The pain is primarily located on the left side and is described as sharp and stabbing. It is exacerbated during intercourse and physical activity. The onset of symptoms began six months ago, with irregular menstrual cycles marked by heavy bleeding and clot formation. Associated signs and symptoms include tenderness in the left lower quadrant, left adnexal tenderness on pelvic exam, and a palpable left adnexal mass on bimanual examination. Exacerbating factors include intercourse and physical activity. The patient denies any relieving factors.

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Current Medications: Ms. Thompson occasionally uses over-the-counter pain relievers for pelvic pain.

Allergies: No known allergies were reported by Ms. Thompson during the interview. She denies any history of allergic reactions to medications, foods, or environmental factors.

PMHx (Past Medical History): Ms. Thompson, G1P1A0, delivered a healthy baby girl named Lily three years ago. Her immunization record is up-to-date, and she reports no significant past illnesses or surgical procedures besides her childbirth experience.

Soc & Substance Hx (Social and Substance History): As a marketing manager, Ms. Thompson leads a busy professional life. She enjoys hiking as a major hobby, is happily married, and resides in a suburban area. She is a non-smoker and occasionally indulges in social drinking. Ms. Thompson practices safety measures, including regular seat belt use and having functional smoke detectors at home.

Fam Hx (Family History): In her family history, Ms. Thompson mentions that her mother had a history of ovarian cysts. Unfortunately, her maternal grandmother passed away due to heart complications. Case Study Discussion For Pelvic Pain And Abnormal Menstrual Bleeding

Surgical Hx (Surgical History): Ms. Thompson has not undergone any significant surgical procedures, as per her reported medical history.

Mental Hx (Mental Health History): She reports no current mental health concerns, history of self-harm practices, or thoughts of suicide or homicide.

Violence Hx (Violence History): Ms. Thompson denies any concerns or issues related to safety, including personal, home, community, or sexual safety—both current and historical.

Reproductive Hx (Reproductive History): Regarding her reproductive history, Ms. Thompson reports regular menstrual cycles, with her last menstrual period (LMP) occurring one month ago. She is currently using barrier contraceptives. Her gravida and parity indicate G1P1A0 (one full-term delivery of Lily). Ms. Thompson is heterosexual and has no reported sexual concerns at this time.

ROS:

GENERAL: No fever, weight loss, or fatigue.

EYES: No visual disturbances, eye pain, or redness.

EARS, NOSE, THROAT: No hearing loss, ear pain, sinus congestion, or sore throat.

CARDIOVASCULAR: No chest pain, palpitations, or edema.

RESPIRATORY: No shortness of breath, cough, or wheezing.

GASTROINTESTINAL: No nausea, vomiting, diarrhea, constipation, or changes in appetite.

GENITOURINARY: As previously mentioned – pelvic pain and abnormal menstrual bleeding.

MUSCULOSKELETAL: Pelvic pain worsened with physical activity; no joint pain or stiffness.

INTEGUMENTARY: No rashes, lesions, or changes in skin color.

NEUROLOGICAL: No headaches, dizziness, numbness, or weakness.

PSYCHIATRIC: Mild anxiety related to ongoing symptoms; no mood changes or sleep disturbances.

ENDOCRINE: No heat or cold intolerance, excessive thirst, or changes in hair or nail growth.

HEMATOLOGIC/LYMPHATIC: No easy bruising, bleeding, or swollen lymph nodes.

ALLERGIC/IMMUNOLOGIC: No history of allergies or immunodeficiency.

Physical Exam:

General: Ms. Thompson appears well-groomed and in no acute distress. Vital signs are within normal limits.

Head: Normocephalic and atraumatic. Hair distribution normal.

Eyes: Pupils equal, round, and reactive to light. Extraocular movements intact. No conjunctival pallor or icterus.

Ears, Nose, Throat: Normal auricles and tympanic membranes. No discharge or tenderness. Nasal mucosa pink and moist. Oropharynx clear without erythema or exudates.

Cardiovascular: Regular rate and rhythm. No murmurs, gallops, or rubs. Peripheral pulses palpable.

Respiratory: Lungs clear to auscultation bilaterally. Respiratory rate within normal limits.

Abdomen: Soft, non-distended. Left lower quadrant tenderness noted. No palpable masses. Bowel sounds present.

Pelvic Exam: Cervix appears normal. Left adnexal tenderness noted. Palpable left adnexal mass appreciated on bimanual exam.

Neurological: Cranial nerves intact. Motor and sensory functions within normal limits. Reflexes symmetrical. Case Study Discussion For Pelvic Pain And Abnormal Menstrual Bleeding

Musculoskeletal: No joint swelling or deformities. Full range of motion noted.

Integumentary: No rashes, lesions, or abnormalities noted.

Rectovaginal Exam: No masses felt. No tenderness on rectal exam.

Diagnostic Results:

  1. Transvaginal Ultrasound: Ordered to evaluate pelvic structures, identify any abnormalities, and assess the size and characteristics of the left adnexal mass.
  2. Pap Smear: Performed to assess cervical health and screen for any abnormalities or signs of cervical cancer.
  3. CA-125 Blood Test: Ordered to assess for ovarian cancer markers, providing additional information about the nature of the left adnexal mass.
  4. Complete Blood Count (CBC): Ordered to assess for signs of infection or anemia, which could be associated with the gynecological condition.

A.

Primary Diagnosis:

Ovarian Cyst (Functional or Pathologic): The primary diagnosis for Ms. Emily Thompson’s presentation is an ovarian cyst. Pelvic pain and abnormal menstrual bleeding, along with left adnexal tenderness and a palpable mass on bimanual examination, are indicative of a possible cyst. The American College of Obstetricians and Gynecologists (ACOG) asserts that ovarian cysts are common in women of reproductive age and frequently present with pelvic pain and irregular menstruation. Transvaginal ultrasound is a crucial diagnostic tool to confirm the existence, size, and characteristics of the cyst (Schallert et al., 2019).

Differential Diagnoses:

  1. Endometriosis: Endometriosis is a plausible differential diagnosis given the nature of pelvic pain exacerbated by physical activity and irregular menstrual bleeding. Although it is less frequent, severe endometriosis cases can have a palpable adnexal mass. Laparoscopy is the gold standard to detect endometriosis, according to a study published in the “Journal of Minimally Invasive Gynecology” (Kiesel & Sourouni, 2019).
  2. Ovarian Tumor or Neoplasm: An ovarian tumor or neoplasm is included in the differentials considering the left adnexal mass and the need to rule out malignancy. The CA-125 blood test is crucial, as elevated levels may suggest ovarian cancer. ACOG recommends CA-125 as a tumor marker, especially in postmenopausal women with an ovarian mass (Charkhchi et al., 2020).
  3. Pelvic Inflammatory Disease (PID): PID is another consideration given the pelvic pain and tenderness. PID is considered particularly if there is a history of recent pelvic infection or sexually transmitted infection. CDC guidelines emphasize the importance of clinical criteria and laboratory testing to diagnose PID accurately (Stewart et al., 2020)Case Study Discussion For Pelvic Pain And Abnormal Menstrual Bleeding .

Plan:

Ovarian Cyst:

  1. Diagnostic Studies: Schedule a transvaginal ultrasound to evaluate the size, characteristics, and location of the ovarian cyst.
  2. Referrals: Consult with a gynecologist for further evaluation and management.
  • Therapeutic Interventions: Prescribe analgesics for pain management. Initiate hormonal therapy if deemed appropriate after gynecological consultation.
  1. Education: Provide patient education on the nature of ovarian cysts, potential treatment options, and the importance of follow-up care.
  2. Disposition: Consider outpatient management unless there are signs of complications or worsening symptoms.
  3. Follow-Up: Schedule a follow-up appointment in 2 weeks for symptom reassessment and review of diagnostic results.

Endometriosis:

  1. Diagnostic Studies: Consider laparoscopy for definitive diagnosis if symptoms persist or overlap with endometriosis,
  2. Referrals: Consult with a gynecologist for consideration of laparoscopic evaluation and potential excision of endometriotic lesions.
  • Therapeutic Interventions: Initiate hormonal therapy based on gynecologist’s recommendations.
  1. Education: Educate the patient on endometriosis, its chronic nature, and the available management options.
  2. Follow-Up: Schedule a follow-up appointment after gynecological consultation to assess treatment response.

Ovarian Tumor or Neoplasm:

  1. Diagnostic Studies: Await results of the transvaginal ultrasound and CA-125 blood test. Consider further imaging studies or biopsy if indicated.
  2. Referrals: Consult with a gynecologic oncologist for evaluation and management if malignancy is suspected.
  • Therapeutic Interventions: Initiate appropriate treatment based on oncologist’s recommendations.
  1. Education: Provide information on ovarian tumors, potential treatment modalities, and the importance of prompt oncological care.
  2. Follow-Up: Schedule a follow-up appointment to discuss diagnostic results and oncology consultation findings.

Pelvic Inflammatory Disease (PID): Case Study Discussion For Pelvic Pain And Abnormal Menstrual Bleeding 

  1. Diagnostic Studies: Perform additional testing, including cervical cultures and laboratory studies, to confirm or rule out PID.
  2. Referrals: Consult with an infectious disease specialist for comprehensive management.
  • Therapeutic Interventions: Prescribe appropriate antibiotics based on infectious disease specialist’s recommendations.
  1. Education: Educate the patient on the importance of completing the antibiotic course and the potential consequences of untreated PID.
  2. Follow-Up: Schedule a follow-up appointment to assess treatment response and ensure resolution of infection.

Reflection

After giving this case some thought, I concur that the preceptor was right to get a transvaginal ultrasound, Pap smear, and CA-125 blood test to fully assess the patient’s symptoms and rule out any possible gynecological disorders. Referrals to infectious disease experts, gynecologists, and gynecologic oncologists are in line with a multidisciplinary strategy to address the differentials. The case study emphasizes the value of working together with experts to handle complicated gynecological issues.

This experience has reinforced the significance of patient education in facilitating informed decision-making. It additionally raised attention to the need to customize treatment programs and educational initiatives by considering the unique patient characteristics of age, ethnicity, and socioeconomic status. In the future, I would stress how patient education should incorporate techniques for illness prevention and health promotion. These might assist in addressing lifestyle factors that could exacerbate gynecological problems and stress the significance of routine screenings and follow-up medical attention. All things considered; this case has helped me to understand the comprehensive approach needed to manage women’s health difficulties.

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References

Charkhchi, P., Cybulski, C., Gronwald, J., Wong, F. O., Narod, S. A., & Akbari, M. R. (2020). CA125 and ovarian cancer: a comprehensive review. Cancers, 12(12), 3730. https://doi.org/10.3390/cancers12123730

Kiesel, L., & Sourouni, M. (2019). Diagnosis of endometriosis in the 21st century. Climacteric22(3), 296-302. https://doi.org/10.1080/13697137.2019.1578743

Schallert, E. K., Abbas, P. I., Mehollin-Ray, A. R., Price, M. C., Dietrich, J. E., & Orth, R. C. (2019). Physiologic ovarian cysts versus other ovarian and adnexal pathologic changes in the preadolescent and adolescent population: US and surgical follow-up. Radiology, 292(1), 172-178. https://doi.org/10.1148/radiol.2019182563

Stewart, L. M., Stewart, C. J. R., Spilsbury, K., Cohen, P. A., & Jordan, S. (2020). Association between pelvic inflammatory disease, infertility, ectopic pregnancy and the development of ovarian serous borderline tumor, mucinous borderline tumor and low-grade serous carcinoma. Gynecologic Oncology156(3), 611-615. https://doi.org/10.1016/j.ygyno.2020.01.027 Case Study Discussion For Pelvic Pain And Abnormal Menstrual Bleeding

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